Decided to see ortho who ordered an MRi last week. I'm sure it is no surprise to you, but when someone is experiencing worsening pain with conventional conservative management like physical therapy this is also not a good sign for a speedy recovery without surgery. I appreciate your thoughts on this matter. There are many sub-types of SLAP tears and varying severity. After surgery, the repair must be protected from certain activities that may put healing at risk. It is important the the surgical repair of the tendon is protected initially to ensure that a re-injury does not occur. My husband just had and MRI and it showed a Nonretracted small insertion full-thickness tear of the supraspinatus tendon. I had an arthogram-MRI which showed a 4 mm near full thickness u-shaped tear involving the supraspinatus tendon anteriorly near but not actually at the numeral attachment. Sorry we are unable to give specific advice over the internet, but I hope this general information is helpful! A full thickness tear is not usually a complete rupture. @DrMikeM: Well, I'm 3 months post injury and still in a tremendous amount of discomfort and pain. The classic full thickness rotator cuff tendon tear involves the supraspinatus and then progresses to involve the long head of biceps, followed by the infraspinatus and subscapularis. @pawpaw911: Hi Pawpaw911, thanks for dropping by. Thanks again Dr. The orthopedic said that after 6 weeks of PT if there is pain then we looka possible surgery, is there something else that I should do or look at? However, worse yet would be delaying in such a way that you miss out on falling pregnant or delivering a healthy baby. Don't be afraid to ask lots of questions about what is likely to happen if you do or don't have surgery. RESULTS: Arthroscopy revealed 21 full-thickness tears, five bursal surface partial-thickness tears, 10 articular surface partial-thickness tears, and 14 patients without tear of the supraspinatus tendon. If your tendon were to completely rupture while you were pregnant, this may be very problematic. (2) In the presence of a full-thickness tear, there is less ability to generate joint torque, hence a positive lag sign. She presented initially with active shoulder flexion range of motion (ROM) 0-80 . Edema is seen involving an intracapsular segment of biceps tendon with possible interstitial tears. It is located in the top portion of the back of the shoulder blade (the superior posterior portion above the spine of the scapula) known as the supraspinatus fossa. J Bone . However, in some cases, the better option may be to consider surgery sooner rather than later (e.g. They will be able to help you return to sport. @anonymous: Thanks for sharing you story Marcia. The first relates to the potential risk of a poorer outcome due to the delay; this may occur due to further damage being caused in structures that are difficult or impossible to repair etc. If they suggest surgery, ask them about what you can expect after surgery and the likely recovery time (including how long it is likely to be before you can use your arm for normal occupational or day to day activities). It must have been quite a knock, there is some quite serious damage there. A few months ago it seemed to hurt more and I had problems lifting my arm out or above my head. There is a moderate amount of fluid distending the subdeltoid bursa maximal over the anterior aspect of supraspinatus and the rotator interval. infraspinatus tendon had full-thickness tear . I'm experiencing the exact same pain you described, and the Army doc told me I was too young to tear a rotator cuff. The acromion joins with the collar bone and attaches to the upper arm (humerus also not shown in this image). The blue arrows indicate a full-thickness tear in the supraspinatus tendon, the most common location for rotator cuff tears. Visited many doctors and was always told it was nothing, the pain got unbearable and I saw yet another dr who was completely caught off guard my the loud pop my shoulder makes. Don't be afraid to say how you feel (no doubt you'd do this in a respectful way) about trying a whole bunch of non-surgical options, but not seeing any lasting results (as you have described for us above) and being keen to move forward toward some kind of resolution to the problem. It is common for patients with known rotator cuff disease to have acute pain and weakness following a minor injury. Thanks for sharing. If you are not keen to rush into surgery don't be afraid to ask your orthopedic specialist about conservative treatment options that may be worth trialing, on the other hand, your surgeon may be able to give you a good indication of whether they think surgery is the most promising option. Rotator Cuff Tears: Surgical Treatment Options. What little I have done has given me improvement. They loaded the muscles under three separate conditions: 1) rotator cuff . If, however, you are active or use your arm for overhead work or sports, surgery is most often recommended because many tears will not heal without surgery. Should this shoulder have an MRI? Children are such a blessing and that time nursing your newborn is such a special and important time. An exercise or physical therapy program is necessary to regain strength and improve function in the shoulder. It is difficult to know whether your husband will need surgery based on this information alone. There is longitudinal split in the subscapularis tendon which extends from the humeral attachment to the musculotendinous junction. My best wishes go to all of them. I'm sorry I can't give you specific advice over the internet about the best option for your situation. I don't know what exactly to do, or what my REALISTIC problem could be. I get asked about this a lot, perhaps I should write a page on rehabilitation following surgical repair of supraspinatus tendon tears! Some things to consider when you are discussing your options with a surgeon is the length of recovery time following surgery (likely to be months), consider time to return to work (also consider whether it it possible for you to return to light duties at work). They will be able to tell you the likelihood of a supraspinatus tear and adhesive capsulitis (or any other pathology), as well as the recommended course of action for your particular circumstance. This can occur due to trauma or repeated micro-trauma and present as a partial or full-thickness tear. I am 60 years old and do not want surgery but if it helps to stop it getting worse as I get older I will have to. i d glad if ortopedist or physiotherapist reply ansver. Good luck! If you get a chance drop by again and let us know how you went. OpenStax College (CC 3.0) via Wikimedia Commons. This can be one of the most frustrating things for people who have whiplash associated disorders. I also have an intermediate grade partial thickness tear of superior tendon bundle of Subscapularis without retraction or muscular atrophy. There are a few interesting things worth noting here. I then went to see another orthopaedic surgeon who said I have whiplash. Also, don't be afraid to ask doctors / surgeons lots of questions. Front view (left) and overhead view (right) of the tendons that form the rotator cuff. Small area of subacromial bursitis present. The use of steroid injection for treatment of a full-thickness rotator cuff tear is still controversial. old I was in good physical shape as a letter carrier(28 yrs) but have been mostly sedentary recovering from the first surgery. . I also can't give you specific advice about your situation over the internet etc. The difficulty with overhead racket sports (like badminton, squash or tennis) is that high level functioning of the rotator cuff muscles are required to stabilise the shoulder joint in what is naturally unstable positions (overhead, and with high speed movement). Supraspinatus tear can be caused by lifting something too heavy, falling on your arm, or dislocating your shoulder. I guess my question is does this always require surgery? patients should expect to return to full work duty by 6-10 months after surgery. Once the full thickness of the tendon is torn, we classify the tears based upon the shape and the number of tendons involved. Let us know how you go! They can then make a diagnosis and begin treatment. 4. It sounds like you may be putting yourself at unnecessary risk? Moderately large joint effusion. The rotator cuff is a group of four muscles and their associated tendons that originate from locations on the scapula and insert onto the humeral head. Starting with Physio treatment is a good idea. I found it very helpful as I am sure all your other subscribers found it to be too. Any thoughts? Particularly about what many people are likely to experience during the often long road to recovery. Infraspinatus tendon is somewhat hetrogeneous in its deep attachment with what appears to be intra-substance tears down to enthesopathic change at footprint. Surgery to repair tendons generally involves a long recovery period. and seemed to be doing ok with Cortisone shots. @Reallmadhatter: Good question. indications. Second, I am sorry to hear about your fall and subsequent shoulder pain. I have spoke with people that have had surgery on their shoulder and they say that is a very painful surgery, and they still have problems from time to time with their shoulder. Above my shoulder or behind my back without pain. @anonymous: Hi LB, Sorry for the delay, I have been away for visiting family for a week or so. When getting a second opinion from another surgeon. If a medical doctor (assuming they have nothing to personally gain by referring you to another health professional) suggests something may work based on their years of training, in depth understanding of anatomy, physiology, common pathology, research evidence and clinical experience with many patients, it is usually worth considering what a family or friend (albeit that they are usually well meaning) is basing their opinion on. They usually present as a sharp pain at the outside or front of the shoulder, particularly with arm elevation (raising the arm to the side or front). Thanks for stopping by and leaving a comment. Supraspinatus tendon tears require specific rehabilitation of the rotator cuff and muscles that stabilize the shoulder blade. Sounds like no guarantee of 100% return to normal, and I'm about 95% now, not to mention a lengthy recovery. I have a feeling this is going to be a long recovery! A few months ago it seemed to hurt more and I had problems lifting my arm out or above my head. That was July of 2011. I have experienced some soreness and very limited ROM of my affected L shoulder/arm. Time passed. I wrote a previous commentsaw my orthopedic surgeon this week. For many years shoulder dislocations were commonly managed by making sure the ball was back in the socket, giving a bit of ice, perhaps some anti-inflammatory medications and putting the arm in an internal rotation sling (a sling that holds the arm near the body with the elbow bent at about 90 degrees). In September '12 I had surgery to reattach both the right rotator supra and infraspinatus with excellent results. while that helped in the short term and improved my left arm motion range, after i stopped the therapy the pain came back and reduced the range. At 55 years of age you still have a lot of living still to do, so don't be afraid to talk openly with your doctor about the success rates for all of the options available to you, and the likely recovery times involved. Either way, don't be afraid to ask your surgeon lots of questions (likelihood of success in your case, what will happen after surgery, recovery time-frames etc.). Pain is really consistent and moderate with moments of severe. perhaps if delay is likely to lead to a complete rupture that could be prevented with early surgery). Failure to do so increases the risk of progression to a supraspinatus tendon full thickness tear. Very much appreciated. INTRODUCTION. Hopefully your doctor can give you specific advice in this regard. Full thickness tear means a complete tear of the rotator cuff supraspinatus tendon. I would make sure your surgeon knows you are planning on falling pregnant within the next 12 months. On one hand, I want the second opinion to be formulated entirely based on my case information (not on what another surgeon did or did not recommend). I will congratulate you on actually doing your exercises! If pain is being caused, then there may be a problem with technique or a lower intensity may be required. Generally speaking, for shoulder pain related to rotator cuff injuries following trauma, often the first strategy is to see whether the pain and other symptoms improve with non-surgical management approaches. Some quite compelling research has indicated that a substantial proportion of people (particularly young people) who receive this kind of treatment will go on to have further shoulder problems (sometimes instability in the shoulder joint or pain and discomfort from damaged structures). damage to the tendon without swelling). is surgery the only option? It has been helpful. Because of the risk of infection and and nerve damage. At approximately the 3:40 mark in the video above, there are a few exercises to help increase the range of the movement in the shoulder. So it would seem strange that your surgeon would expect adhesive capsulitis to resolve with 6 weeks of physical therapy, unless you had already had the condition for many months and he had started to detect improvement? Any suggestions and generally how long is the recovery period? Osteophytes and inferior capsular swelling indents the superior margin of the mytendinous junction of supraspinatus. 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